Faculty Profile

Stewart Justman

Personal Summary

“The aspects of things that are most important for us are hidden because of their simplicity and familiarity,” wrote Wittgenstein.

Informed by respect for things hidden in plain sight, much of my work probes the fallacies of salience, the magic of publicity, the slanting of attention itself. A paper in the Journal of the Royal Society of Medicine, for example, investigates the use of public-relations techniques in cancer screening. I am a practitiioner of constructive skepticism.

My recent book The Nocebo Effect: Overdiagnosis and Its Costs (Palgrave 2015) documents the transformation of normal problems into medical ones, bringing out the risks of this inflationary practice. Ills as well as goods can be shaped from raw materials, packaged, popularized. But once ambiguous ills inherent in human existence are labeled—branded—as a consequence of massive publicity, the experience of having them in the first place can change This is the only study to consider the effects of diagnostic inflation on the diagnosed.

My interest in the prosaic draws me to Montaigne, a critic of charisma and defender of the ordinary.

Montaigne viewed the medicine of his time with a well-merited skepticism and had remarkable insight into its best resource, the placebo effect. Because less separates biomedicine from its early-modern counterpart than commonly supposed, he still has much to teach about the workings of this potent variable. When we improve as a result of surgery that didn't take place, or for that matter sicken as a result of fumes that elude detection, we behave much like our counterparts in Montaigne’s world. But doctors as well as patients are subject to errors of perception and inference. It was the hope of correcting misleading impressions with more reliable knowledge that led mid-20th century investigators of the placebo effect to propose the sort of methodologically demanding trials through which drugs are now run before coming to market.

In the spirit of constructive skepticism, many of my recent papers, including that on Montaigne, concern the evaluation of evidence. How are we to understand James Lind's confessions of failure even after he successfully conducted the first clinical trial? What are we to make of a drug that passes some clinical trials but not others? What are we to make of Freud's high-handed way with evidence, as well as his cultivated resemblance to the fantasy hero, Sherlock Holmes? How does a prior belief in the guilt of the accused act on the evidence against him or her?

Selected Publications

Medical

"Deception and Transparency in Placebo Research," Yale Journal of Biology and Medicine 86 (2013): 323-31. As words come to resemble therapeutic agents in their own right, it's only to be expected that experimenters would use language in subtly leading and misleading ways to elicit the effects they are looking for.

"Pills in a Pretty Box," in Placebo Talks: Modern Perspectives on Placebos in Society, ed. Amir Raz and Cory Harris (Oxford: Oxford University Press, 2015). In discussions of antidepressants it is sometimes overlooked that one who takes them does so in tandem with millions of others, as if swept up in a common wave.

"Placebos in the Clinic," Journal of the Royal Society of Medicine 106 (2013): 208-09.The preference for placebos with an appearance of medical legitimacy suggests that doctors are uneasy with the practice of deception even if they are not about to abandon it.

To Feel as Others Feel: Social Sources of the Placebo Effect, University of California Medical Humanities Press, 2013. See http://escholarship-ucmedicalhumanities.lulu.com/spotlight. A humanist looks at the placebo effect, taking into account both its history and its ambiguity and bringing out the more questionable potential of some health fashions, trends and movements of our own time.

"Placebo: The Lie That Comes True?", Journal of Medical Ethics 39 (2013): 243-48. We should consider the placebo effect as a therapeutic benefit arising from the conscientious performance of the rituals of good medicine, not as a resource to be tapped by the use of trickery (with equivocations counting as trickery) or dispensed in the form of pills.

"Artificial Epidemics," published for e-readers by Now and Then Reader. In the absence of appropriately discerning methods, the screening of large populations is bound to create problems.

Publications

Medical

"The Weight of a Term: 'Substantial Evidence' and Buried Data," Perspectives in Biology and Medicine 61 (2018): 201-14. When Congress amended the Food, Drug, and Cosmetic Act in 1962 to ensure the efficacy of drugs before they reach the market, it imposed a standard of evidence distinctly weaker than the reasonable one of preponderance.

"When Checklists Were New: The Prototype of DSM's Operational Criteria," Ethical Human Psychology and Psychiatry 20 (2018): 17-26. With the triumph of the DSM diagnostic system and the MDD diagnosis in particular, a checklist that originally served as a device for research into an imperfectly understood disorder, and was not proposed for general adoption, reified and became a formula for diagnosis on a mass scale.

"James Lind and the Disclosure of Failure," Journal of the Royal College of Physicians of Edinburgh 47 (2017): 384-87. In confessing his lack of an unfailing remedy for scurvy and his trouble making sense of the disease's behavior, Lind did medicine a greater service than by conducting his now-famous trial.

"Montaigne on Medicine: Insights of a 16th-Century Skeptic," Perspectives in Biology and Medicine 58 (2015): 493-506. In the world of Montaigne’s Essays the imagination can both induce and relieve impotence. By analogy, it has been shown that simply informing men of the low risk of sexual dysfunction associated with a beta-blocker can increase the incidence of that adverse effect dramatically, and that the resulting dysfunction can be successfully reversed with placebo

The Nocebo Effect: Overdiagnosis and Its Costs, Palgrave Macmillan, 2015.As normal conditions are branded as medical issues, they acquire powerful, suggestive labels that readily come to life in our minds and bodies.

"Pills in a Pretty Box," in Placebo Talks: Modern Perspectives on Placebos in Society, ed. Amir Raz and Cory Harris (Oxford: Oxford University Press, 2015). In discussions of antidepressants it is sometimes overlooked that one who takes them does so in tandem with millions of others, as if swept up in a common wave.

"The Medicalization of Misspelling: DSM and the Management of Life," Academic Questions 28 (2015): 322-33. Published, Online First, July 25, 2015. To a hammer everything looks like a nail, and to the DSM everything, even misspelling, looks like a disorder.

"Can I Author Myself? The Limits of Transformation," Journal of Medicine and Philosophy 40 (2015): 511-28. One reason you can't remake your life in the image of a story is that life is not to be mistaken for story in the first place.

"Trauma for Everyone: How PTSD Became the Malady of Millions," published for e-readers by Now and Then Reader, May 2015. PTSD comports uneasily with the DSM diagnostic system, and one doubts that the implications of mixing psychiatric diagnosis and oppositional polemics were well thought out at the time.

"The Finasteride Riddle," Journal of Symptoms and Signs 3 (2014): 154-59. It's because PSA testing grew into a mass movement, with the excesses inseparable from such a movement, that the urologists who set this phenomenon going are now looking for ways to rein in its harms.

"The Folly of Systems: The Satiric Tradition and Mental Disorders," Philosophy and Literature 37 (2013): 472-85. "Who can sufficiently speak of these symptoms?" asks Burton.

"Deceit and Transparency in Placebo Research," Yale Journal of Biology and Medicine 86 (2013): 323-31. The trickery of placebo experimentation goes beyond straightforward lies to include the use of artful ambiguities, half-truths, and deliberate omissions in informational scripts and “verbal suggestions."

To Feel as Others Feel: Social Sources of the Placebo Effect, University of California Medical Humanities Press, 2012. The placebo effect can't be reduced to the expectation of a patient in a social vacuum like those engineered in many studies where placebos serve either as controls or the focus of research. It is a social phenomenon with a life of its own, just as a social movement served as the carrier of the mysterious energy known as Mesmerism—the object of the first scientific investigation of the placebo effect. Mesmerism drew followers as if socially magnetic.

"Artificial Epidemics," published for e-readers by Now and Then. In the absence of appropriately discerning methods, the screening of large populations is bound to create problems.

"Do No Harm: A Case in Point," Perspectives in Biology and Medicine 55 (2012): 291-98. As the transcript of a charged meeting shows, the principle of avoiding harm is far from an inert doctrine without application to medicine.

"Uninformed Consent: Mass Screening for Prostate Cancer," Bioethics 26 (2012): 143-48. The full implications of the harm to which ill-informed men have subjected themselves during the PSA era are now becoming manifest.

"What's Wrong with Chemoprevention of Prostate Cancer?", American Journal of Bioethics, December 2011. This article was posted as a "target" for commentaries, to which I reply in "Forfeited Health: A Reply to My Critics" (online only). If not for the unintended consequences of PSA testing, would we even be discussing the preventive use of drugs associated with aggressive cancer?

"To Feel What Others Feel: Two Episodes from 18th-Century Medicine," Medical Humanities 37 (2011): 34-37; published online in advance of print. Neither a tree nor water could be magnetized, but the followers of Mesmerism might still be magnetized to one another.

"The Power of Rhetoric: Two Healing Movements," Yale Journal of Biology and Medicine 84 (2011): 15-25. By professing to be in touch with a power in the human body, both doctrines [EMDR and Mesmerism] acquire real power in the form of a following.An alternate text of this article is available from the author.

"From Medicine to Psychotherapy: The Placebo Effect," History of the Human Sciences 24 (2011): 95-107. Even as the routine use of placebos in medical practice lost legitimacy, the placebo effect in the form of suggestion flourished in the practice of psychotherapy.

"How Did the PSA System Arise?", Journal of the Royal Society of Medicine 103 (2010): 309-12. If you search Amazon for "cancer awareness," you will find knee socks, pen, lanyards, and stickers, but no books.

"Imagination's Trickery: The Discovery of the Placebo Effect," Journal of the Historical Society 10 (2010): 57-73. We cannot afford to overlook our vulnerability to medical delusions, one of the discoveries of the Enlightenment.

"Reticence in Action: The Antisepsis Controversy," Journal of the Historical Society 9 (2009): 427-41. While hospitals could be likened to fields of death, the thought that not chance but the surgeon was killing patients was not so readily admitted.

"A Preventive Slippery Slope," Hastings Center Report, March-April 2009. When the PSA revolution got going twenty years ago no one could have intended the ensuing epidemic of prostate cancer.

Do No Harm: How a Magic Bullet for Prostate Cancer Became a Medical Quandary. Chicago: Ivan R. Dee, 2008. The finasteride controversy is important not only in itself and as an omen of the future conundrums of chemoprevention but as an instance and marker of the trend toward population-based medicine. Reviewed in New England Journal of MedicineJune 5, 2008. [Note: On Dec. 1, 2010 the FDA's Oncologic Drugs Advisory Committee recommended against the use of finasteride and dutasteride for chemoprevention. This book was cited in the course of discussion.]

Seeds of Mortality: The Public and Private Worlds of Cancer. Chicago: Ivan R. Dee, 2003. Recipient of the 2004 PEN Award for the Art of the Essay. Polls showing that 90 percent of respondents would like to be told they are dying bring to mind elections where 99 percent vote for the anointed candidate.

Literary

"Sherlockismus: Freud and the Romance of Detection," forthcoming in Philosophy and Literature. The fact is that no one can actually solve cases with stunning inferences à la Sherlock Holmes, much less discern another’s “most intimate thoughts” from casual indications (another of his imputed abilities), because the Sherlock Holmes stories are fantasies.

"Abuse of the Dead: A Comment on 'American Despair in an Age of Hope,'" Salmagundi 176 (2012): 127-37.

"Literature and Propaganda," Salamgundi 174-75 (2012): 203-21.Concurrently with the circulation of propaganda stories about Muhammad, the mobilization of military and intellectual power against Islam, and the attempt to argue the rival religion out of existence by the force of superior dialectic, Latin Europe engaged in commerce and cultural commerce with its adversary.

"From Aesop to Orwell: The Roots of Doubletalk," Connor Court Quarterly (Australia), April 2012. Chernyshevsky saturates with vagueness the most earthbound and detailed of all literary forms, a form which Orwell himself practiced and in whose tradition he was steeped: the novel.

"The Advertisement of Guilt," Soundings 93.1-2 (2010): 163-73. They protest not their innocence but their guilt, and they protest too much.

"Oriental Tales and Great Expectations," Dickens Quarterly, 27 (2010): 38-47. Some of the core tales of the Arabian Nights are devoid of the marvelous, except insofar as the extravagance of human delusions is marvelous in itself.

"Stiva's Idiotic Grin," Philosophy and Literature 33 (2009): 427-34. Nothing is better able to render the details and dynamics of the ego's fantasy life than fiction itself, capable though fiction may also be of playing with our minds and confusing our vision.

"Dr. Humbert," Raritan, Fall 2009: 33-39. A theoretically ideal patient, highly intelligent, well versed in the conventions of psychiatry, willing to tell all, an anthology of symptoms, is revealed as both ruthless and incurable.

"Converts and the Novel," Philosophy and Literature 32 (2008): 359-72. The moral life of humanity is so complex, and the forces bearing on the convert so strong and so many--including threats, enticements, and the alluring prospect, or at least hope, of being embraced rather than despised by one's fellow creatures--that for whatever is known about Jews who embraced Christianity, more must remain unknown if not unknowable.

"Tolstoy's Wisdom and Folly: A Review of Gary Saul Morson's Anna Karenina in Our Time: Seeing More Wisely," Literary Imagination 10 (2008): 352-57. In every question of interpretation Morson's appeal is to the text--sometimes to a passage perceptibly inflected with irony, sometimes to a clause folded in the middle of a sentence, sometimes to an explicit editorial comment, sometimes to entire patterns, but in any case to the page itself.

"Literature and the Turn from History,"Literary Imagination 10 (2008): 25-35. While no one would deny that many things are excluded from representation in Jane Austen's pages, the same is true of any work of fiction.

"The Secularism of Fiction: A Medieval Source," Literary Imagination 10 (2008): 127-41. Although our terminology disposes us to think of Christian civilization and Islamic civilization as walled kingdoms, each complete unto itself and a stranger to the other, these worlds were not hermetically sealed.

"The Uncaged Bird: Pop Psychology and Its Sources," Salmagundi, Winter 2008. In the very things that distinguish it from traditional advice literature--its tone of accusation and rhetoric of rights, both derivatives of the 1960s--pop psychology as we know it bears the sign of its origin.

Shakespeare: The Drama of Generations. Delhi: Macmillan, 2007. The flash of brilliance, the leap out of the ordinary, the break with existing practice, the violation of norms, the sudden discontinuity--all exert a powerful attraction.

Literature and Human Equality. Evanston: Northwestern University Press, 2006. The elevation of commoners into positions of importance not only changed the appearance of literature but made possible new ways of constructing a tale.

Fool's Paradise: The Unreal World of Pop Psychology. Chicago: Ivan R. Dee, 2005. Recipient of the Popular Culture Association's Ray and Pat Browne Award for the best book of 2005 by a single author. Martin Luther King proclaims that the time has come for freedom, Phil McGraw that that time has come for wellbeing.

"All Is Not As It Should Be: The Nature of Liberal Guilt," Salmagundi, Summer 2004. What can be more futile than fretting over the past?

The Springs of Liberty: The Satiric Tradition and Freedom of Speech. Evanston: Northwestern University Press, 1999. If the novel is unbound by the presuppositions of other genres (thus constituting a sort of supergenre), the freedom of satire is such that it overflows every generic boundary and its power such that it animates different genres in the first place.

The Psychological Mystique. Evanston: Northwestern University Press, 1998. Psychology is the clue to all things: he who understands the formation of ideas can reform the world.

"Freud and His Nephew," Social Research, Summer 1994: 457-76. "Bernays aspired to be a sort of practical Freud, emancipating people from the past and correcting the malfunctions of an industrial society." Cited as recommended reading in American Psychological Association Monitor, December 2009.

Online publications:

"Trigger Warnings and Mass Psychogenic Illness," published on Quillette.com, Nov. 2, 2018. Much as illness raced through a Tennessee high school not as a result of a toxic exposure but because those affected got swept up in a frenzy of imitation, demands for trigger warnings raced from coast to coast in recent years in a kind of epidemic manner

"When 'Believe the Victim' Backfires," published on Quillette.com, Oct. 6, 2018. Investigators who interpret equivocal evidence as highly incriminating (because they interpret it in the light of a compulsory belief in the guilt of the accused) may find themselves leading the victim down a garden path that ends in a court of law.

"Stimulants: The Long View," published as a Mad in America blog, 10/03/17. See https://www.madinamerica.com/2017/10/stimulants-the-long-view/. When ADHD crusaders use phrasing like "a preference for the long-term over the short-term outcomes of behavior," their words resonate precisely because, like the body of a violin, ithey are hollow.

"Psychoanalyst, Show Some Modesty," published as a Mad in America blog, 08/05/17. See https://www.madinamerica.com/2017/08/psychoanalyst-show-modesty/. Psychoanalysts may claim the right to judge public figures, but in the United States the authority of psychoanalysis suffered a collapse decades ago from which it never recovered.

"Science in Wonderland: A Case in Point" published Nov. 25, 2008 on Butterfliesandwheels.com, a website devoted to "fighting fashionable nonsense." Prevention is so strongly associated with the utopian tradition, and utopian notions continue to exert such attraction, that even medical research may find itself drawn to utopianism by a kind of gravitational pull.

"Investment in the Placebo Effect" published August 3, 2008 on Butterfliesandwheels.com. Psychotherapy is a playground of placebo effects.

Position Papers

"Storm Clouds: The 'Warning Signs' Fallacy." The notion that shocking events are preceded by legible warnings, and could therefore have been prevented if only the warnings were heeded, obscures the self-evident truth that it's easier to predict events after they occur. To view, click HERE.

"School Massacres: Terror and Impunity." Had Cho lived, some would have said, without fail, that his ruthlessness proves his insanity, that this executioner of 32 strangers was unmercifully tyrannized by his own delusions, and the care he put into preparing his rampage and cutting off his victims’ lines of escape only shows how detached from everyone and everything he really was. To view, click HERE.

"Dirty Hands: On Margarethe von Trotta's 'Die Andere Frau.'" Guided by the film's leanings, we credit Vera with the superior truth--the authenticity--of one who has pierced the falsity of bourgeois existence. To view, click HERE.

"Pills That Talk: Therapy and the Marketplace." Advertised drugs yield psychological rewards without the bother of psychotherapy. To view, click HERE.

"Murder and Dandyism: In Cold Blood Reconsidered." Dandy coolness is an informing principle in a work that relates the unthinkable with never-failing composure. To view, click HERE.

To view my unpublished letter to the New York Review of Books in defense of Frederick Crews's biography of Freud, click HERE.

"No Excuses: A Review of Lukianoff and Haidt's Coddling of the American Mind." Contending that iGen’s highly protected upbringing distorted their cognition, made them oversensitive to danger, and incapacitated them for the free exchange of ideas, they portray the entire lot as victims of their own childhood. To view, click HERE.

"Marriage in Ruins: Broadchurch." The deployment of adultery at certain critical points in Broadchurch represents an awkward attempt to give it plot importance now that its actual importance has evaporated. To view, click HERE.